MEDICARE: JORGE LUIS PEREZ CASTELLANOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1902603046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE LUIS PEREZ CASTELLANOS

Provider Business Mailing Address
First Line	:	601 E DANIA BEACH BLVD APT 1428
Second Line	:
City	:	DANIA
State	:	FL
Zip	:	33004-3128
Country	:	US
Telephone Number	:	956-649-9889
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 E DANIA BEACH BLVD APT 1428
Second Line	:
City	:	DANIA
State	:	FL
Zip	:	33004-3128
Country	:	US
Telephone Number	:	956-649-9889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2025
Last Update Date	:	02/26/2026

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